Benefits & Claims

Once you're logged in, you can find a good amount of info on your claims or benefits by selecting the Claims or Benefits items in the menu. You can also find some basic info by looking on the back of your ID card.

If you don't find answers to your questions, please call Member Services at the number listed on your ID Card.

Consumer-driven health plan (CDHP) is a high-deductible plan that also includes a tax-free health savings account (HSA), health incentive account (HIA) or health reimbursement account (HRA). You may put tax-free money into your account, or your employer might put money in - sometimes as a reward for steps you’ve taken for better health, depending on your plan. Then you use that money for your share of care costs, like your deductible or coinsurance.

It’s called consumer-driven because it puts you in the driver’s seat of your health and health care spending. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

Health Savings Account (HSA) plan is a high-dedutible plan that also includes a tax-free HSA. You can put tax-free money into it. Then use that money for your share of care costs, like your deductible or coinsurance. You can see all of the types of costs you can cover with money in your HSA. But remember that only cost your plan covers will go toward paying down your deductible.

It gives you the flexibility of a PPO - you can often go to doctors in and out of your network, though you’ll get better rates with in-network doctors. HSA plans tend to have lower monthly premiums than similar PPOs, and sometimes even HMOs.

It’s sometimes called a consumer-driven health plan (CDHP) because you’re in more control of your care spending at first. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

A health savings account (HSA) is a bank account that can be used to pay for health expenses. You or your employer can put tax-free money into your HSA. You’ll use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year and beyond. You can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.

You (or sometimes your employer) can put tax-free money into your health savings account (HSA). Then you use that money to pay for your share of care costs, like your deductible or coinsurance. Some people cover for all their care costs with their HSA dollars - since your checkups and other preventive care are already covered at 100%. Also, your plan comes with tools to help you find quality care at a lower cost.

If you still have money left in your account, it stays in there for next year and beyond. And you can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.

A health incentive account (HIA) is a health account set up by your employer health plan. You earn dollars in your account when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

Your employer puts money into your health incentive account (HIA) when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

COBRA is a federal law that enables employees and their covered dependents to maintain their group health coverage for 18, 29 or 36 months after becoming ineligible for regular group coverage. The COBRA law does not apply to group health plans maintained by a small employer (normally fewer than 20 employees on a typical business day).

To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. But you must elect to participate in the FSA during your employer's open enrollment.
For dependent care FSAs, you must also have children under the age of 13 (if divorced, you must be the custodial parent). Or if you have an adult you can claim as a dependent on your tax return, who’s physically or mentally unable to care for themselves.

Qualified individuals must meet one of the following criteria; children under the age of 13 or any adult you can claim as a dependent on your tax return that is physically or mentally unable to care for him/herself.

The IRS does not allow Health Care FSA funds to be used for over-the-counter (OTC) medicines without a prescription. We encourage you to talk to your doctor and request a letter of medical necessity for any over-the-counter medicines or supplies that you frequently need to utilize. Also check IRS Publication 502 for a complete list, including OTC items, of what is covered by your Health Care FSA.

Generally, individuals become eligible to enroll in Medicare when they reach age 65, or are disabled and have been receiving Social Security Disability Income (SSDI) checks for 24 months, or have a diagnosis of either end-stage renal disease or ALS (Lou Gehrig’s Disease).

While the law allows people to maintain their group health coverage and coordinate it with Medicare, anyone covered by a group plan who is planning on enrolling in Medicare should check their group plan's eligibility rules to find out their plan’s rules regarding Medicare enrollment, and to determine which insurance is primary (pays first), and which is secondary. Watch the relevant dates carefully, and beware that eligible individuals only have 80 days to enroll in Medicare Part B after their group health benefits end, or face paying a higher Part B premium as penalty.

The work-related expense test is the standard the IRS uses to determine if expenses are work related for a Dependent Care FSA. An expense is not considered work-related just because you had it while you were working. Expenses are considered work-related only if both of the following are true:

They allow you (and your spouse if filing jointly) to work or look for work

The IRS limits contributions to your Health Care FSA to $2,550 per year. If you are married, each spouse may contribute up to $2,550 to his or her own Health Care FSA, even if both have the same employer.

The entire amount you’ve elected to put into your Health Care FSA is available on day one of your plan, even if you’re contributing a portion each month. You can use your funds by logging in to this site. You’ll see info on your FSA — you can select health care claims you want to pay with those dollars. You can also pay expenses then submit a reimbursement form with a receipt.You must use your FSA dollars by the end of your plan year. Most plans will give you a grace period of a month or more to submit expenses that you incurred during your plan year. If you don’t use all of the money in your account, you forfeit it.

Unused funds typically don’t roll over. There may be a run-out period when you can continue to submit expenses from the plan year, or your employer may allow up to $500 to carry over to the next plan year. Any balance after that is forfeited to your employer. Some plans offer a grace period that lets you both continue to make purchases and submit reimbursement requests after the end of the plan year. After that, any unused balance for the previous year goes back to your employer.

You must submit documentation. It can be an itemized receipt, invoice, explanation of benefits or other, but must include the patient name, name of the provider/pharmacy, the service/item purchased, date of the service/transaction, and dollar amount. If used for prescribed over-the-counter items, you must also include a letter of medical necessity detailing the condition being treated, medication type and dosage, and duration of the treatment. Letters of medical necessity must be renewed each year.

You can only enroll and set how much you’re putting into it during your enrollment period at your company. However, if you have a change in your life such as getting married or divorced, a new child, moving residence, etc. - contact your company’s Human Resources. You may qualify for a special enrollment period, and you’ll be able to make changes to your FSA.

Your employer decides if your FSA has a run-out period. During a run-out period you can submit a claim for expenses from the FSA plan year. Unused funds will be forfeited.Talk to your company’s Human Resources to see how your company’s FSA works, as soon as possible. You can also call us at the number on your Anthem ID card.

FSA plans typically include a time past the plan year for reimbursement requests for expenses during the plan year (known as a run-out period) or expenses up to the end of the extension (known as a grace period). Consult your HR department for details.

Once we receive enrollment data from a state health insurance exchange marketplace, we process the information as quickly as possible and mail a payment letter to you as the customer. This payment letter serves as your receipt of enrollment. When everything works smoothly, this should only take about 10 days. However, sometimes processing the data can take time, especially if we need to go back and make sure any of the information is correct. There can also be issues with the initial application that keeps us from being able to process it, which will need to be corrected at your state’s health insurance exchange marketplace. If you’ve been waiting longer than a couple of weeks to receive your letter, you will want to check on the status of your application - either with us or with the health insurance exchange marketplace. Click on the Contact Us tab to speak with an Anthem representative.

You should receive your ID card within about 10 days of paying your first premium. If you need care and you haven’t gotten your ID card yet, ask your doctor to call us to confirm your benefits -and to make sure they’re in your health plan network.

Call us at the number on the back of your Anthem ID card. There is a grace period to help you avoid having your coverage canceled. If you pass the grace period, your policy is canceled from the date you stopped paying. Any claims you had during that time will be denied and you will be responsibile for full payment of the health care services you received. You can re-enroll during the next yearly open enrollment.

Once you receive your payment letter, it will share directions for you to pay the first month’s premium. Payment of the first monthly premium is required to start the policy according to the details shared in your letter. You must take this step to activate your policy before your health insurance identification cards (ID cards) can be mailed.

If you’re the primary person on your policy, you can view your info as well as some of your dependents’. When dependents are over 18, we have certain privacy rules in place that may restrict your access. But you can always change that by having that dependent log into their own profile and change who can view their info.

Typically, if you are the subscriber continuing with the same employer, and you move outside of the area we serve, if your place of employment is not located within the service area, your coverage and your dependents' coverage terminates as of your moving date. Potentially, your coverage may be picked up by the local Blue Plan (visit bcbs.com for details). If you are a covered dependent and you move out of the service area, you may still be eligible for coverage. Check your contract or Certificate for more information.

Check with your employer, as well as your contract or Certificate for more information. There is a federal law known as COBRA which might apply. If COBRA applies to you, you have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium. You may also be eligible to convert to an individual policy of coverage offered by Anthem. This is typically known as a "conversion privilege".

Note: If a service was authorized by us before termination, but is not rendered until after your coverage ends, Anthem is not responsible for paying benefits for such services.

Check your contract or Certificate for more information. There are several possibilities:

If you are eligible under a federal law known as COBRA, you may have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium.

Your employer may offer retiree coverage.

You may have the opportunity to convert to an individual policy offered by Anthem.

You may have the opportunity to continue coverage under your group coverage.

Contact your employer or Customer Care for more information and for eligibility guidelines that apply to you.

If you are the employee through whom you and your dependents are receiving benefits, you will need to check your contract or Certificate and talk to your employer for more information. If a covered dependent becomes disabled, coverage for that dependent may continue while your coverage is in force until the dependent is Medicare eligible. Contact your employer or Customer Care for more information and for eligibility guidelines that apply.

Typically, if your spouse was covered under your health benefit plan, he/she would cease being eligible for coverage through your contract upon the divorce. However, because of a federal law known as COBRA which might apply, your former spouse may be able to retain independent coverage under your employer's coverage for some period of time, provided he or she pays the full amount of their premium. He or she might also be able to obtain coverage through his/her employer, through other affiliations, or purchase individual coverage. He or she may also be eligible to convert to an individual policy of coverage offered by Anthem.

If new coverage is obtained within certain time frames, waiting periods and medical underwriting might not apply. Contact your employer, your Certificate or Customer Care for more information and for any guidelines that apply.

Check your contract or Certificate. If you are covered through an HMO benefit design, pre-existing conditions will be covered. In other types of product designs, it will depend on what your contract says, and whether or not you were covered by another contract prior to being covered through your current contract. Contact Customer Care for more information and for guidelines that apply to you.

How is my HIA funded?
The health plan makes an annual allocation to your HIA. You also have the opportunity to earn extra money for your HIA by taking certain steps to improve your health. If you joined the plan after your company’s benefits became effective, your HIA allocation may be prorated. You will still need to meet the plan’s full deductible before your traditional health coverage begins. Check your Plan Summary for information about your annual HIA allocation.

When can I use my HIA allocation?
Your HIA funds are available on your first day of coverage.

What type of services may I pay for with my HIA funds?
You can use the money in your HIA to pay for health care services covered by the Lumenos plan, such as doctor’s office visits, prescription drugs, and lab tests. Check your Plan Summary for more information on covered services.

What is traditional health coverage?
Similar to a PPO or HMO plan, after you meet your deductible, you pay coinsurance (a percentage of the provider’s charges) when you visit a network provider. You’ll pay more if you visit an out-of-network provider. Check your Plan Summary for more information on coinsurance amounts.

How do I check my health account balance?
It’s easy. First register then log in to this website. You can keep track of your account and balance and get details on your medical claims. You’ll also receive a monthly statement with your account balance, account activity, medical and prescription claim history and important messages about how you may be able to improve your health or save money.

Can I roll over all the money in my HIA at the end of each plan year?
Yes. Whatever you don’t spend on covered services will roll over to the next year, as long as you remain enrolled in the Lumenos HIA plan. You can use roll-over funds to help pay future out-of-pocket expenses.

If I leave this Lumenos plan, what happens to my HIA funds?
You cannot take your HIA funds with you if you leave the plan or your employer. The funds in your HIA stay with the health plan.

How is my HIA funded?
Your HIA is funded when you earn rewards for taking certain steps to improve your health. Check your Plan Summary for more information about earning rewards.

What type of services may I pay for with my HIA funds?
You can use the money in your HIA to pay for health care services covered by the Lumenos plan, such as doctor’s office visits, prescription drugs, and lab tests. Check your Plan Summary for more information on covered services.

What is traditional health coverage?
Similar to a PPO or HMO plan, after you meet your deductible, you pay coinsurance (a percentage of the provider’s charges) when you visit a network provider. You’ll pay more if you visit an out-of-network provider. Check your Plan Summary for more information on coinsurance amounts.

How do I check my health account balance?
It’s easy. First register then log on at anthem.com. You can keep track of your account activity and balance, and get details on your medical claims. You’ll also receive a monthly statement with your account balance, account activity, medical and prescription claim history and important messages about how you may be able to improve your health or save money.

Can I roll over all the money in my HIA at the end of each plan year?
Yes. Whatever you don’t spend on covered services will roll over to the next year, as long as you remain enrolled in the Lumenos HIA plan. You can use roll-over funds to help pay future out-of-pocket expenses.

If I leave this Lumenos plan, what happens to my HIA funds?
You cannot take your HIA funds with you if you leave the plan or your employer. The funds in your HIA stay with the health plan.

Can I have an HSA and an FSA?
You are eligible to have both an HSA and an FSA only if the FSA has been defined as either a Limited/Special Purpose FSA, which may be limited to dental and/ or vision services or dependent care only or a Limited Purpose High-Deductible FSA, which also allows for dental and/or vision services, as well as payment for the coinsurance under the traditional health component of the plan, after meeting the deductible.

Contributions to your Health Savings Account (HSA)

How is my HSA funded?
Your HSA is funded by your own pre-tax contributions, up to a certain annual limit. You may also contribute post-tax money to your HSA. Others (including your employer) may contribute to your account as well. You can earn additional dollars for your HSA by taking certain steps to improve your health. The total of all contributions cannot exceed the maximums defined by the U.S. Treasury and the Internal Revenue Service (IRS). (See the question below: How much can I contribute to my HSA? for details.)

How do I make contributions to my HSA?
The easiest way is through pre-tax payroll deductions, if allowed by your employer. However, you may also contribute directly to your HSA post-tax, by sending a check to the address printed on your HSA checkbook.

How much can I contribute to my HSA?
For 2010, the annual contribution maximum set by the U.S. Treasury and the IRS is $3,050 for individual coverage and $6,150 for family coverage. The contribution maximums set by the U.S. Treasury and the IRS may be increased for inflation annually. Check anthem.com for the most current maximum amounts.

Can I ever contribute more than the annual limit?
Yes, people age 55 and older who are not enrolled in Medicare are eligible to contribute an additional $1,000 above the regular limits (called a catch-up contribution). These individuals can make catch-up contributions each year until they enroll in Medicare. On

When your doctor gives you a prescription for a drug, take it to a pharmacy in your network. Show your member ID card so the pharmacist can access your benefits. If you have ongoing medicines you take, you may be able to get them sent right to your door.

You can log in and use our Find a Doctor tool to help you find a pharmacy. You can also see and manage your prescription benefits or start home delivery.